Clinical Retrospective Study Of Laparoscopic Distal Pancreatectomy

Objective:Through analysing the statistic of the cases of laparoscopic distal pancreatectomy in our hospital,we compare LSPDP with LDPS,and compare the results of the LDP(Kimura-the method of preserving splenic vessels)with the LDP(Warshaw-the method in dissecting the splenic arteriovenous system)in the LSPDP group.We analyze the patients'effects of general,intraoperative,postoperative and clinical date,and the influencing factors of the pancreas.To summarize the experience of laparoscopic pancreatic body and tail surgery,and to provide the help for clinical treatment.Methods:In this study,82 patients who were performed LDP from March 2014 to February 2019 in Shandong Provincial Hospital,were selected(exclusion of cases with simple enucleation of pancreas,conversion to laparotomy,and postoperative pathology as malignant).Among them,49 cases underwent laparoscopic distal pancreatectomy with spleen preservation(LSPDP group).The LSPDP group can be divided into two groups:distal pancreatectomy with preservation of splenic vessels(Kimura)in 43 cases and distal pancreatectomy without splenic vessels(Warshaw)in 6 cases.The other 33 cases received laparoscopic pancreatectomy combined with splenectomy(LDPS group).The data of the general condition(sex,age,weight),intraoperative condition(amount of bleeding during operation,operation time,management of pancreatic stump)postoperative conditions(fasting time,postoperative hospital stay,incidence of pancreatic impotence,blood routine)and the factors that might affect the occurrence of pancreatic fistula were compared and analyzed in 82 patients.In order to further exclude the influence of tumor size on the comparison between LSPDP group and LDPS group,we selected only those cases whose postoperative pathology was benign or borderline and the diameter of tumor was?4cm:33 cases in LSPDP group and 13 cases in LDPS group.Then all cases of LSPDP were compared,including 43 cases in Kimura group and 6 cases in Warshaw group.Reasult:Between LSPDP group and LDPS group,there was no significant difference in sex,age,weight,intraoperative bleeding and fasting time(P>0.05).In the mean operation time,there was a significant difference between LSPDP group and LDPS group(228.18±34.95min VS 178.85±36.73 min).On postoperative hospitalization,LSPDP group was significantly higher than LDPS group(6.93 ±2.30 days VS 8.94±3.37 days),and there was statistically significant between the two groups(P= 0.019).In the PLT,LSPDP group and LDPS group(215.06 ±57.13 ^ 109/L VS 444.15±170.14 ^ 109/L),There was significant difference.The incidence of pancreatic fistula in LSPDP group was significantly lower than that in LDPS group(21.21%VS 61.54%)(P=0.023).The incidence of pancreatic fistula(23.26%VS 6.67%)in Kimura group was significantly higher than that in Warshaw group(P = 0.027).The postoperative pathology of 82 patients was analyzed.The tumor diameter in LSPDP group was significantly higher than that in LDPS group(3.75±2.19cm VS 5.52 ±3.07 cm),P<0.001),and there was a significant difference in tumor size between the two groups.In the postoperative complications,the postoperative fever(>38.5 ?)(18.18%VS 38.46%)in the LSPDP group was significantly higher than that in the LDPS group(P=0.015).There was no significant difference in the factors that might affect pancreatic fistula,such as age,sex,spleen preservation,operation time,intraoperative bleeding,blood transfusion and stump management by binary Logistic regression analysis(P>0.05).However,the level of serum albumin before operation was significantly correlated with the occurrence of pancreatic fistula(P=0.007).Conclusion:1.Although LSDPD operation was more complicated and the operation time was longer,the incidence of postoperative pancreatic fistula and postoperative fever in LSDPD group was lower than that in LSDPD group,and the postoperative recovery was faster,the days of hospitalization were shorter,and the spleen function was preserved in LSDPD group.There was no significant increase in platelet count in patients after operation,which reduced the risk of thrombotic complications after operation.Therefore,LSDPD may be considered to be more advantageous than LDPS.2.The diameter of the tumor is larger;the tumor has compressed and invaded the spleen vessel or the hilum of the spleen;if the inflammatory reaction is serious,the more difficult it is to preserve the spleen,the lower the success rate is.3.Compared with Warshaw method,the incidence of pancreatic fistula and the risk of spleen infarction after operation by Kimura method were lower than those by Kimura method.4.0n the factors influencing the occurrence of pancreatic fistula,it was found that the level of albumin before operation was significantly different from that of pancreatic fistula.The patients with hypoproteinemia before operation were more likely to have pancreatic fistula after operation.In the management of pancreatic stump,laparoscopic resection and intermittent suture closure were not found to be effective in reducing pancreatic fistula compared with simple incised closure.